National Nurses United

12 N A T I O N A L N U R S E W W W . N A T I O N A L N U R S E S U N I T E D . O R G J A N U A R Y | F E B R U A R Y | M A R C H 2 0 2 6 CALIFORNIA I n early january, registered nurses of California Nurses Association (CNA), the union that spearheaded our state's historic, first-in-the-nation safe RN-to- patient ratios standard for general acute-care hospitals, strongly objected to major flaws in the state's December proposal to set similar ratios in acute psychiatric hos- pitals (APHs) and called for corrections to the proposal to establish real, meaningful ratios that all patients deserve. CNA nurses have been advocating for the California Department of Public Health (CDPH) to protect nurses and patients in APHs with the same safe RN-to-patient ratios protec- tions as general acute-care hospitals. On Jan. 21, nurses from across the state held a march in Sacramento, the state capital, to highlight their concerns that new staffing standards being considered for acute psychi- atric hospitals will be used by the hospital industry to weaken the state's historic RN-to- patient ratios legislation. CNA represents more than 100,000 nurses across California and is an affiliate of National Nurses United (NNU). "The new ratios for acute psychiatric hos- pitals can, should, and must extend the standards from existing ratios for general acute-care hospitals," said Sandy Reding, RN and CNA president. "We fully support RN ratios for acute psychiatric hospitals, and we want the nurses in those hospitals to have the same strong standards the rest of us do." Among nurses' top concerns are the inclusion of licensed vocational nurses (LVNs) and psychiatric technicians in the staffing ratios, management-run staffing committees without RN inclusion, and workarounds to minimum RN staffing ratios including the creation of a new "RN on duty" who can be responsible for up to 24 patients at one time in a 12-hour shift or 16 patients in an 8-hour shift, which translates into 30 minutes per patient for the entire shift. That time is insufficient to provide ini- tial and ongoing observation and assessment of patients, as well as nursing care, and makes the proposed APH staffing ratios meaningless. Currently, in general acute-care hospitals in the state, only registered nurses count toward the ratios, and pediatric units must be staffed at or better than one nurse for every four children. Instead of using the same safe staffing standard that patients receive in general acute-care hospitals, CDPH is proposing that in APH facilities, up to half the personnel used to count staffing can be LVNs or psych techs, and that only one nurse is needed for every five children. While nurses whole- heartedly agree that LVNs and psych techs are important mem- bers of the care team, they cannot substitute for the educa- tion, judgment, and skills of registered nurses. Through this proposal, the state is attempting to fulfill the original requirements of A.B. 394 (Kuehl, 1999), the law that CNA nurses fought for more than a decade to win so that patients could get safe, quality care and nurses could provide safe, quality care. However, CDPH's proposed APH staffing regulations are riddled with major problems and loopholes that make the rec- ommended ratios essentially worthless. Even worse, the draft APH ratios as written threaten and undermine the legitimacy of the stronger RN ratios standards already in place for general acute-care hospitals. With this draft proposal, the state is caving in to the hospital industry and money-driven psych hospitals that want to keep their profit margins higher by keeping staffing costs low—at the expense of patient safety. Hospitalized patients deserve the same standard of care no matter what kind of facility they are in, but the state is proposing an inferior staffing standard for acute psy- chiatric hospitals compared to general acute-care hospitals, and that's unacceptable to CNA nurses. Hospital employers will want to apply the proposed inferior stan- dard across the industry. As an investigative series in the San Francisco Chronicle showed, insufficient staffing is severely hurting and even leading to the death of psychiatric patients. Mean- ingful staffing reforms are desperately needed in APHs to prevent further harm. Research has unequivocally concluded that RN-to-patient ratios in California's gen- eral acute-care hospitals save lives, and they will in acute psychiatric hospitals as well if we establish real standards that ensure there are enough RNs to provide the safe and quality care all patients deserve. —Lucy Diavolo and Lucia Hwang RNs march in Sacramento to protect RN-to-patient ratios Also demand strong ratios for acute psychiatric hospitals NEWS BRIEFS

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